A Swiss study has shown that personalised nutrition support for people hospitalised with chronic heart failure reduced their risk of dying compared to those given standard hospital food.
Patients with malnutrition were most likely to benefit, which is unsurprising given it’s well established that malnutrition is associated with poorer patient outcomes – including people with heart failure.
The study randomised more than 600 people admitted to eight hospitals with chronic heart failure to nutrition support aimed at meeting their energy, protein and micronutrient needs or to a control group offered normal hospital food.
Support, followed up with advice on discharge, included food fortification with protein powder, or tube feeding where necessary (in about 5% of patients), oral nutrition supplements and snacks between meals. There was no salt restriction and fluid intake was tailored to the individual.
Overall, nutrition risk was clearly linked to risk of death over the short- and long-term, with nearly 40% mortality over six months.
This was ameliorated by nutrition support: after 30 days, 8.4% of people in the treatment group had died compared to 14.8% in the control group. They also had lower risk of major events such as a heart attack.
Indeed, the link between nutrition and heart failure is not rocket science.
“Much of heart failure today is concentrated at the intersection of poor diet quality with diabetes, renal disease, hypertension, and coronary heart disease,” writes Sheldon Gottlieb, from the Johns Hopkins School of Medicine, US, in a related editorial.
These stats bore out in the current sample in which about a third of people had diabetes, half had hypertension and a third had coronary heart disease.
Yet Gottlieb notes that little attention is paid to the role of diet in heart failure other than recommending reduced salt intake. In fact, he adds, the 2021 American College of Cardiology recommendations for optimising heart failure treatment devoted about a whole five words to diet and exercise.
“This study adds another tile to the still-fragmentary mosaic picture of the patient with heart failure at nutritional ‘risk who might benefit from nutritional support,” he writes.
“‘Good medical care’ dictates that all hospitalised patients deserve to have a standardised nutritional assessment.”
Natalie Parletta is a freelance science writer based in Adelaide and an adjunct senior research fellow with the University of South Australia.
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